Healthcare Provider Details

I. General information

NPI: 1548512213
Provider Name (Legal Business Name): ALLCARE RHEUMATOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18077 RIVER AVE
NOBLESVILLE IN
46062-8303
US

IV. Provider business mailing address

PO BOX 68952
INDIANAPOLIS IN
46268-0952
US

V. Phone/Fax

Practice location:
  • Phone: 317-214-6420
  • Fax: 317-214-6015
Mailing address:
  • Phone: 317-870-0480
  • Fax: 317-870-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: TRINH TRAN
Title or Position: AUTHORIZED REPRESENTATIVE
Credential: M.D.
Phone: 317-214-6420